Policy Manual sample

MDT Home Health Care Agency, Inc. 107 NURSING INTERVENTIONS: 1. Apply warm soaks and gently attempt removal again in 15-30 minutes. 2. If unsuccessful, notify the physician. 3. DO NOT PLACE FORCE OR PULL ON THE CATHETER. 4. STOP if any resistance is met when removing the catheter. 5. Notify the physician immediately. SIGNS OF A FRACTURED PICC OR MIDLINE: • Profuse leaking of IV fluids from the insertion site. • Patient complaining of popping, burning or stinging sensation during flushing or removal. • Catheter not removed intact:  If catheter pre-trimmed at 45 degree angle, look for angled tip on the catheter. If the tip is still 45 degrees, the catheter has not been fractured.  Look for round closed-end tip on the Groshong type catheter.  Compare insertion measurement and measurement upon removal which should be the same. EMERGENCY NURSING PROCEDURE FOR A FRACTURED CATHETER: 1. Apply tourniquet immediately to the upper arm in the axillary area. • If at home, use a belt, scarf or necktie as a tourniquet. • If the lower extremity is the insertion site then apply the tourniquet to the upper thigh area. • The objective is to hold the catheter fragment in place, preventing it from entering the central circulation and impede blood flow. • DO NOT REMOVE THE TOURNIQUET UNTIL A PHYSICIAN IS PRESENT. • Minimize patient activity. 2. Confirm the radial pulse is present. • Continue to frequently assess pulses distal to tourniquet. • In the case of the insertion site being in the lower extremity, check the presence of a dorsalis pedal or popliteal tibial pulse. • DO NOT COMPLETELY OCCLUDE BLOOD FLOW TO THE EXTREMITY. The goal is to occlude venous flow but do not impede arterial blood flow. 3. Notify the physician immediately. 4. Initiate emergency transfer to a medical facility for further assessment and intervention. The nurse will not leave the patient until emergency personnel has arrived. DOCUMENTATION: Record the assessment findings and procedure, including the length of the catheter, the presence of damage or fracture, appearance of the insertion site, dressing application, patient/family instructions and the patient’s tolerance of the procedure. Document physician notification and any instructions received. ____________________________________________________